Rural hospitals are often under served with respect to pediatric specialty and emergency services. As a consequence, acutely ill and injured children presenting to rural hospitals may receive delayed or inappropriate care. The use of telemedicine to provide under served hospitals with pediatric emergency and critical care telemedicine consultations has not been described, and the effect that these consultations would have on the processes, frequency of errors, outcomes and costs of health care provided to children is unknown. The objective of this application is to determine the impact of telemedicine consultations on the quality and satisfaction of care that critically ill and injured children receive in rural emergency departments. Preliminary data suggests that telemedicine consultations to a rural hospital can aid in the management of critically ill children. The candidate hypothesizes that emergency pediatric telemedicine consultations to rural, under served emergency departments will reduce the frequency of medication errors; enhance the quality of care as measured by implicit review; and decrease unnecessary patient transports. Furthermore, it is hypothesized that these departments will be regarded as high in quality compared to control emergency departments without telemedicine consultations. Two rural, under served emergency departments will be studied that will utilize telemedicine consultations for acutely ill and injured children (Telemedicine ED). The acutely ill and injured children presenting to the two matched control emergency departments (Control ED) will act as control subjects. Historical control data will be collected from all four emergency departments so that a pretest-posttest design with concurrent matched controls can be used. UC Davis Children?s Hospital critical care physicians will provide consultations to the rural emergency departments. Review of the blinded medical records will be used to determine medication error rates, implicit quality assessments, and patient transfer rates in the telemedicine and control emergency departments. Satisfaction surveys completed by the parents/guardians will also be compared between patients cared for in telemedicine and control emergency departments to evaluate the effects of telemedicine on overall patient satisfaction.